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- May 4, 2009
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Must vent.
We had just taken one of the patients whom I was covering overnight to the OR to debride what was left of her pancreas (infected necrotic pancreatitis by cx). 6 hours later around midnight, I got a page from the ICU fellow who was worried that she was developing abdominal compartment syndrome - for some reason the unit team had done a bladder pressure, which was 45. Her belly was distended but still soft, and all other indicators were normal including airway pressures, labs were all stable, and nothing incriminating from any of the bazillion drains. She had gone oliguric sometime during the operation, we assumed as a result of shock, so urine output wasn't a big player at that point.
I wasn't very concerned for ACS, but hey I'm still an intern for the next two months, what do I know. So I called up my fellow at home, gave him the hard data and my exam and impressions, and he agreed that the bladder pressure was probably off (as they tend to be). I explained this to the ICU fellow and he seemed to understand - besides, the patient was rock stable, or at least as stable as she could be s/p pancreatic debridement.
Two hours later, with the patient still ridiculously stable, I got a page from the ICU attending (who had been called by the ICU fellow), to discuss the same data which hadn't changed. In the meantime they had done another bladder pressure and it was 50; the patient's belly was still soft. At this point the unit attending is actively trying to run me over to impose his point, so I woke up my fellow again and they had a nice long chat. We finally agreed to paralyze the patient and redo the bladder pressures and behold, they came back in the low 20s. Patient stable, case closed.
We find out the next day that after all this, the unit attending had attempted to call OUR ATTENDING at 3am to try to convince him to take the pt back to the OR in the middle of the night behind our backs.
I do appreciate that these guys were trying to do the right thing, but for God sakes that was taking it a bit too far, especially trying to live or die by the bladder pressure. It was one of my last nights on float at the mothership and to add that time sucking charade to all the preexisting BS - the aggravation was overwhelming and it was all I could do to keep things civil (which they were, until we woke my fellow up the second time).
Sorry for the rant. I've seen more than a few consults this year for r/o abdominal compartment syndrome, and each one has hinged on faulty bladder pressures - is this generally a common theme?
neb
We had just taken one of the patients whom I was covering overnight to the OR to debride what was left of her pancreas (infected necrotic pancreatitis by cx). 6 hours later around midnight, I got a page from the ICU fellow who was worried that she was developing abdominal compartment syndrome - for some reason the unit team had done a bladder pressure, which was 45. Her belly was distended but still soft, and all other indicators were normal including airway pressures, labs were all stable, and nothing incriminating from any of the bazillion drains. She had gone oliguric sometime during the operation, we assumed as a result of shock, so urine output wasn't a big player at that point.
I wasn't very concerned for ACS, but hey I'm still an intern for the next two months, what do I know. So I called up my fellow at home, gave him the hard data and my exam and impressions, and he agreed that the bladder pressure was probably off (as they tend to be). I explained this to the ICU fellow and he seemed to understand - besides, the patient was rock stable, or at least as stable as she could be s/p pancreatic debridement.
Two hours later, with the patient still ridiculously stable, I got a page from the ICU attending (who had been called by the ICU fellow), to discuss the same data which hadn't changed. In the meantime they had done another bladder pressure and it was 50; the patient's belly was still soft. At this point the unit attending is actively trying to run me over to impose his point, so I woke up my fellow again and they had a nice long chat. We finally agreed to paralyze the patient and redo the bladder pressures and behold, they came back in the low 20s. Patient stable, case closed.
We find out the next day that after all this, the unit attending had attempted to call OUR ATTENDING at 3am to try to convince him to take the pt back to the OR in the middle of the night behind our backs.
I do appreciate that these guys were trying to do the right thing, but for God sakes that was taking it a bit too far, especially trying to live or die by the bladder pressure. It was one of my last nights on float at the mothership and to add that time sucking charade to all the preexisting BS - the aggravation was overwhelming and it was all I could do to keep things civil (which they were, until we woke my fellow up the second time).
Sorry for the rant. I've seen more than a few consults this year for r/o abdominal compartment syndrome, and each one has hinged on faulty bladder pressures - is this generally a common theme?
neb